Paget’s disease of bone is a rare disorder having unknown etiology. It is observed in old age and is rarely seen in people less than 40 years of age. The disease is characterized by enlargement, softening and bone deformity. Basically it is a disease caused due to malformation of bone growth which results in weakness of bone and frequent fractures.
Paget’s disease usually affects bones of pelvis, skull, spine and legs; however any bone in the body can be affected.Besides bone problems the disease can lead to nerve damage, especially the spinal nerves and also result in hearing loss.
Management includes administration of analgesics and non inflammatory drugs to relieve pain. Certain other medicines are given to strengthen the bones. If the mainstay treatment fails surgery may be necessary to correct the deformation.
What Causes Paget’s Disease?
The exact cause of pagets disease still remains unknown to scientists.Members of medical fraternity suspect it to be caused due to environmental as well as genetic cause. There are several genes that are known to be suspected to cause paget’s disease of bone. Besides genes some researchers also link virus, especially paramixovirus nucleocapsid to be the causative agent. However, the connection between virus and paget’s disease still remains to be proved.
Paget’s disease of bone generally affects people more than 40 years of age. Men are affected more than women. The disease is also more prevalent in people of European origin. A person having family history of paget’s disease is at a greater risk of developing this condition.
Symptoms Of Paget’s Disease Of Bone
Majority of patients suffering from paget’s disease of bone are asymptomatic. This means there are no clinical findings and the bone abnormality is detected only on routine radiological examination. When symptoms are present, pain is the most common symptom, especially in the joints. There is local warmth and tenderness over the affected bone.
As in this disease there is rapid generation of bone cells than normal, the faster remodeling of bones causes the bones to remain soft and weak than the normal bone. This often leads to mild to moderate bone pain, bone deformities and frequent bone fractures.
The disease may be localized in one or two areas or may involve many other areas. When the overgrowth of bones occurs in skull bones, patient may develop hearing loss or headache. Compression of spinal cord due to soft bone can lead to paralysis. The leg bones are bent leading to misshapen legs.
Diagnosis And Treatment Of Paget’s Disease
Physical examination, radiological study and blood tests help to diagnose paget’s disease. During physical examination the doctor can recognize deformity of bone. Laboratory findings reveal raised level of serum alkaline phosphate. Blood calcium and phosphorus level are usually normal. X-ray is helpful in diagnosis.
The affected bone appears enlarged, deformed and devoid of clear outline. The normal trabecular structure of bone is absent. When x-ray findings are inconclusive, technetium 99m diphosphonate scans are done to find the extent of disease.
People who do not have any symptoms may not need any treatment. But if the symptom manifestation is present supported by elevated serum level of alkaline phosphatase, than treatment is necessary. Treatment will also lower the risk of complications besides alleviating symptoms. Certain drugs that are used for osteoporosis are also beneficial in strengthening the bones that become weak in paget’s disease.
Patient is also advised for exposure to sunlight for a dose of vitamin D. Patient may also increase the amount of calcium intake naturally by drinking milk and dairy products that are rich source of calcium. In rare cases surgery may be needed for healing of fractured bones. It may also be needed to reduce pressure on nerves and for proper alignment of deformed bones.